Appearance of gas collections after scuba diving death: a computed tomography study in a porcine model

• Published in: International journal of legal medicine 2013-01, Vol.127 (1), p.177-184
• Main Authors: Laurent, Pierre-Eloi, Coulange, Mathieu, Bartoli, Christophe, Boussuges, Alain, Rostain, Jean-Claude, Luciano, Michel, Cohen, Frederic, Rolland, Pierre-Henri, Mancini, Julien, Piercecchi, Marie-Dominique, Vidal, Vincent, Gorincour, Guillaume
• Format: Article
• Language: English
• Subjects: Anesthesiology; Animals; Aorta - pathology; Aortography; Autopsies; Barotrauma; Brain - pathology; Cardiopulmonary resuscitation; Case-Control Studies; Cerebrovascular Circulation; Coronary Circulation; CPR; Diving - adverse effects; Embolism, Air - diagnostic imaging; Embolism, Air - pathology; Embolisms; Emphysema; Forensic Medicine; Forensic Pathology; Gases; Liver Circulation; Medical imaging; Medical Law; Medicine; Medicine & Public Health; Models, Animal; Nitrogen; Original Article; Phlebography; Postmortem Changes; Resuscitation; Scuba & skin diving; Subcutaneous Emphysema - pathology; Swine; Time Factors; Tomography; Tomography, X-Ray Computed; Topography; Ultrasonography, Doppler, Pulsed; Veins - pathology
• ISSN: 0937-9827; 1437-1596
• DOI: 10.1007/s00414-011-0662-6

Introduction Postmortem computed tomography can easily demonstrate gas collections after diving accidents. Thus, it is often used to support the diagnosis of air embolism secondary to barotrauma. However, many other phenomenons (putrefaction, resuscitation maneuvers, and postmortem tissue offgassing) can also cause postmortem gas effusions and lead to a wrong diagnosis of barotrauma. Objectives The aim of this study is to determine topography and time of onset of postmortem gas collections respectively due to putrefaction, resuscitation maneuvers, and tissue offgassing. Materials and methods A controlled experimental study was conducted on nine pigs. Three groups of three pigs were studied postmortem by CT from H0 to H24: one control group of nonresuscitated nondivers, one group of divers exposed premortem to an absolute maximal pressure of 5 b for 16 min followed by decompression procedures, and one group of nondivers resuscitated by manual ventilation and thoracic compression for 20 min. The study of intravascular gas was conducted using CT scan and correlated with the results of the autopsy. Results The CT scan reveals that, starting 3 h after death, a substantial amount of gas is observed in the venous and arterial systems in the group of divers. Arterial gas appears 24 h after death for the resuscitated group and is absent for the first 24 h for the control group. Concerning the putrefaction gas, this provokes intravenous and portal gas collections starting 6 h after death. Subcutaneous emphysema was observed in two of the three animals from the resuscitated group, corresponding to the thoracic compression areas. Conclusion In fatal scuba diving accidents, offgassing appears early (starting from the first hour after death) in the venous system then spreads to the arterial system after about 3 h. The presence of intra-arterial gas is therefore not specific to barotrauma. To affirm a death by barotrauma followed by a gas embolism, a postmortem scanner should be conducted very early. Subcutaneous emphysema should not be mistaken as diagnostic criteria of barotrauma because it can be caused by the resuscitation maneuvers.